Recurrent disease following liver transplantation for nonalcoholic steatohepatitis cirrhosis

• Published in: Liver transplantation Vol. 15; no. 12; pp. 1843 - 1851
• Main Authors: Malik, Shahid M., deVera, Michael E., Fontes, Paulo, Shaikh, Obaid, Sasatomi, Eizaburo, Ahmad, Jawad
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.12.2009
• Subjects: Adult; Aged; Biopsy; Case-Control Studies; Fatty Liver - complications; Fatty Liver - mortality; Fatty Liver - pathology; Fatty Liver - surgery; Female; Humans; Incidence; Kaplan-Meier Estimate; Liver Cirrhosis - etiology; Liver Cirrhosis - mortality; Liver Cirrhosis - pathology; Liver Cirrhosis - surgery; Liver Transplantation - adverse effects; Liver Transplantation - mortality; Male; Middle Aged; Recurrence; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome
• ISSN: 1527-6465; 1527-6473
• DOI: 10.1002/lt.21943

Recurrence of the original disease following liver transplantation is not uncommon and can lead to graft failure. There are limited data on recurrent fatty liver disease following liver transplantation. The aim of this study was to determine the incidence of recurrent fatty liver disease in patients with biopsy‐proven nonalcoholic steatohepatitis, its effect on survival, and whether there are any predictive factors for recurrence. We analyzed patients undergoing liver transplantation for nonalcoholic steatohepatitis cirrhosis from 1997 to 2008 at a single center. Patients undergoing transplantation for cholestatic disease, alcohol, hepatitis C, or cryptogenic cirrhosis were controls. Ninety‐eight patients underwent transplantation for nonalcoholic steatohepatitis cirrhosis. Recurrent fatty liver disease was seen in 70%, 25% had recurrent nonalcoholic steatohepatitis, and 18% had stage II/IV or greater fibrosis at a mean of 18 months. No patients with recurrent nonalcoholic steatohepatitis developed graft failure or required retransplantation at a follow‐up of 3 years. No recipient or donor factors were associated with disease recurrence, although patients with recurrent nonalcoholic steatohepatitis had a higher incidence of diabetes, weight gain, and dyslipidemia at the time of diagnosis of recurrence. One‐third of patients with recurrent nonalcoholic steatohepatitis had normal liver enzymes at the time of diagnosis post‐transplantation. In conclusion, recurrent fatty liver disease is common following liver transplantation for nonalcoholic steatohepatitis cirrhosis but does not lead to early allograft failure. Recurrent nonalcoholic steatohepatitis can occur despite normal liver enzymes, and features of metabolic syndrome are associated with disease recurrence. Liver Transpl 15:1843–1851, 2009. © 2009 AASLD.